In Canada there were an estimated 16,020 people living with HIV who were undiagnosed in 2014, as well as about 2,570 new infections. That’s slightly down from the estimated 2,800 new infections in 2011, but still a cause for concern. But now there may be some signs of hope from across the pond.
Four sexual health clinics in London, UK, recently saw a significant decrease in new HIV infections among gay men, and some believe that it was due to people buying PrEP online.
This success has been largely attributed to some DIY activists in the UK and websites like PrEPster and I Want PrEP Now. They offer comprehensive information on how to buy and use generic versions of PrEP, as well as things to do before and after you start taking it.
Some Canadians have already been importing generics. So can we expect similar results here?
One site, Davie Buyers Club is doing great work by providing information on how Canadians can access generics, though he focuses on the Vancouver area. It offers an in-depth step-by-step tutorial on how to get PrEP for about $75 Canadian per month.
However, the difference between the UK and Canada is that you can’t actually have them shipped to your home since PrEP generics have not been approved by Health Canada. While Health Canada and the Canada Border Services Agency will allow you to import three months worth of PrEP, you have to carry it across the border yourself it with a copy of your prescription. So how does one get access?
According to Davie Buyers Club how it works is that you first need to get a prescription from your primary care provider so that you can order them online and import them back to Canada. You next need to get a mailbox in the United States so that you have an address to ship them to. They’re legal there because they’re FDA-approved. Davie Buyers Club provides a list of other parcel receiving services in the US depending on where you are in Canada. You then order, wait, and pick them up when they arrive.
I spoke to “Davie,” the creator of the site, who is a front line health care worker in the capacity of a doctor, nurse or a nurse practitioner (to protect his identity, he cannot specify).
Davie admits that this method benefits those who have some risk with moderate to high means, since you need a car, a passport and no prior criminal record to get PrEP this way. Those who are high risk with low means may not find this approach accessible, especially if you don’t live near a border.
“Having to go to another country to receive your medications is a significant barrier,” he says.
A personal concern I have with this method is possible interruptions in access due to issues with shipping or at customs, which can happen when ordering online. A recent cohort study in northern California showed a rise in STI rates amongst PrEP users, though the STIs are a cause for concern, what actually got my attention was that two people in the study contracted HIV during periods when their insurance lapsed, interrupting their access. Although their interruption was due to issues with insurance and not ordering online,what this tells me is that even if access changes, risky behaviour may not.
“There is always — hopefully a very small — but some level of uncertainty and I feel like it’s my job to describe the process as best and as clearly as possible, to make people follow the process to make it go as smoothly as possible,” Davie says. “I start my webpage with a disclaimer that there is an element of risk to this.”
Many may feel that ordering generic drugs online is questionable because the drugs may contain the wrong ingredients, they may be counterfeits or have toxic additives, or they may be past their expiration date. Obviously, finding a reliable source is essential.
I Want My PrEP Now only lists PrEP suppliers with first-hand accounts from people they know who claim that the sales process was straightforward and reliable. The drugs have also been tested by customers.
In 2014, Mylan, the pharmaceutical company that Davie’s website recommends, announced that it received tentative approval for its generic version of Truvada by the United States Food and Drug Administration (FDA) as an antiretroviral. Apparently it meets all safety, efficacy and manufacturing quality standards for marketing.
Last year, one sexual health clinic in central London tested drug levels of users who purchased their PrEP online from various sources; there were no counterfeits found, a promising result.
Whether to begin generics is ultimately a decision that one must make, either with the help of a primary care provider, or on their own. Though it may seem radical or even dangerous to some, the apparent success in London was because gay men defied medical advice and ordered generics anyway.
So will Canada also see a decrease in HIV transmission cases thanks to buying PrEP online?
“I don’t think we’re quite there yet,” Davie says.
Perhaps the only hope for PrEP to make an impact is to have it publically funded nationwide. Currently in Canada, only Quebec residents, people with private drug coverage that covers PrEP, students, and people who are enrolled in the First Nations and Inuit Health Care plan can access PrEP. The Canadian Drug Expert Committee recommended that Truvada be reimbursed, but one of the conditions is that Truvada’s manufacturer, Gilead, provides the drug at a reduced price. Whether Gilead will do so remains to be seen.